title: Screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy: results of the European Heart Rhythm Association survey.
abstract: The purpose of this EHRA survey was to examine the current clinical practice of screening and risk evaluation for sudden cardiac death in ischaemic and non-ischaemic cardiomyopathy with a focus on selection of candidates for implantable cardioverter-defibrillator (ICD) therapy, timing of ICD implantation, and use of non-invasive and invasive diagnostic tests across Europe. A systematic screening programme for sudden cardiac death existed in 19 out of 31 centres (61.3%). Implantation of ICDs according to the inclusion criteria of MADIT-II and SCD-HeFT trials was reported in 30 and 29% of centres, respectively, followed by MADIT-CRT (18%), COMPANION (16%), and combined MADIT and MUSTT (7%) indications. In patients with severe renal impairment, ICD implantation for primary prevention of sudden death was always avoided in 8 centres (33.3%), was not used only if creatinine level was >2.5 mg/dL in 10 centres (32.2%), and in patients with permanent dialysis in 8 centres (33.3%). Signal-averaged electrocardiography and heart rate variability were never considered as risk stratification tools in 23 centres (74.2%). Implantation of a loop recorder was performed in patients with borderline indications for ICD therapy in 6 centres (19.4%), for research purposes in 5 (16.1%), and was never performed in 20 (64.5%) centres. In conclusion, the majority of participating European centres have a screening programme for sudden cardiac death and the selection of candidates for ICD therapy was mainly based on the clinical risk stratification and not on non-invasive and invasive diagnostic tests or implantable loop recorder use.
authors.affiliation: Department of Cardiology Azienda Ospedaliero-Universitaria and IRCAB Foundation Udine, Italy. proclemer.alessandro@aoud.sanita.fvg.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Proclemer
authors.forename: Thorsten
authors.initials: T
authors.lastname: Lewalter
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bongiorni
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Svendsen
authors.forename: Jesper Hastrup
authors.initials: JH
authors.lastname: Nielsen
authors.forename: Laurent
authors.initials: L
authors.lastname: Pison
authors.forename: Carina Blomström
authors.initials: CB
authors.lastname: Lundqvist
mesh_terms: D009202:Cardiomyopathies / Q000175:diagnosis* / Q000401:mortality* / Q000517:prevention & control; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D005060:Europe / Q000453:epidemiology; D019538:Health Care Surveys; D006801:Humans; D008403:Mass Screening / Q000379:methods; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D018579:Patient Selection; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
keywords: EHRA survey; EP wire; Implantable cardioverter-defibrillator; Ischaemic cardiomyopathy; Non-ischaemic cardiomyopathy; Risk stratification; Screening; Sudden cardiac death